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Sports Concussions May Last Longer in Girls

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A new study on sports concussions concludes that symptoms such as headache lasted more than twice as long in young female athletes than for young male athletes.

Few studies over the years have focused on possible gender differences in sports concussions, injuries that shake the brain and can cause symptoms—usually short-term—such as headaches, nausea, and disorientation.

The findings in this latest study, published this week in The Journal of the American Osteopathic Association, "confirm what many of us have thought for a long time,” says John Neidecker, D.O., the study's lead author and a Raleigh, N.C., sports concussion specialist.

We still have much to learn, however, say a number of experts, before we come to firm conclusions on gender differences.

"This is a very interesting observation," says neurologist Orly Avitzur, M.D., Consumer Reports' medical director. "But more research is needed to determine what factors may be contributing to prolonged recovery from concussion in girls."

Here, what we know about concussion-related gender differences so far, and what you need to do to protect your young athletes.

Understanding This Study

The new study looked at the medical records of 110 male and 102 females between 11 and 18 years of age who had experienced first-time concussions while playing team sports such as football, soccer, or hockey.

The researchers found that 75 percent of the boys recovered fully within three weeks. But the same held true for only 42 percent of the girls.

What Other Research Suggests

Some studies suggest that girls not only may be slower to recover from a head blow but also may be more likely than boys to experience concussions. The study published in the Journal of Athletic Training in March, for example, found that the rate of concussions was 56 percent higher in girls than in boys—in sports that both genders played.

"We know the risk of concussion is greater for girls than boys when playing sports with the same rules—soccer, basketball, baseball/softball—multiple studies support this," says Christopher Giza, M.D., a professor of pediatric neurology and neurosurgery and director of the UCLA Steve Tisch BrainSPORT Program.

The types of symptoms tend to vary by gender as well, according to longtime concussions researcher R. Dawn Comstock, Ph.D., professor of epidemiology at the Colorado School of Public Health. "In my work with high school students, we see a higher proportion of boys with concussions report symptoms like loss of consciousness, amnesia, extreme confusion, and a higher proportion of girls report things like noise sensitivity, light sensitivity, or sleep disturbances," she says.

It's unclear whether these seeming gender differences truly mean that girls are at higher risk for concussion or more likely to have a slower recovery, says Comstock: "Or, are girls more aware of subtle signs and symptoms and more willing to report concussion symptom? Are the adults around youth sports perhaps a little more protective of girls than boys?"

Researchers are also trying to pin which of a number of possible factors—from headaches to physiology to hormones—may be the cause of any gender differences.

What's probable, says Comstock, is that there are multiple factors at play. "The only thing we know for sure is that concussion rates are different, and the one thing that everybody can agree on is that a previous injury increases the risk of subsequent concussion and possibly one that’s more severe," she says.

The Right Steps to Take

Currently, there are no gender-based recommendations for concussion prevention or treatment. But both boys and girls need to be properly educated, says CR's Avitzur: “Teach them about the signs of concussion and make sure they will tell someone if they get hurt." And consider the following:

Protect them. Make sure coaches, trainers, and young athletes are taking the proper preventive steps during games and practices. (Here, what our experts recommend.)

Help them get strong. Consider asking coaches and trainers about exercises to strengthen the neck. "Girls' neck muscles are weaker, so their shock absorber system is not as strong," says Robert Cantu, M.D., clinical professor of neurology and neurosurgery at Boston University Medical School and cofounder of its Chronic Traumatic Encephalopathy (CTE) Center. "So girls should be doing resistance exercises to strengthen their necks—as guys should."

Make sure they know when to get out of the game. Kids should leave the field if they, or an adult on hand, suspect a concussion—and return only when they've been cleared by a doctor. A study presented at the Academy of Pediatrics 2017 National Conference & Exhibition in September found that adolescent girls were almost three times as likely as adolescent boys to return to play on the day they sustained a soccer-related concussion, which can put them at risk of serious injury. See the right steps for diagnosing and treating a concussion and when to see the doctor if symptoms haven't resolved.

Be aware of the possible risks of noncontact activities. Contact sports may have the highest rates of concussion, but activities such as snowboarding and cheerleading can also pose a risk. Although overall concussion rates in cheerleading, for example, are low, head blows are the most common injury in the sport, according to a study published in 2015 in the journal Pediatrics.